From the patient's perspective, pain is the hallmark of any orthopedic injury, especially where fractures and dislocations are involved. Compounding the problem is the high degree of anxiety that many patients (especially children) feel when the problem must be managed acutely in the emergency department (ED). Emergency physicians (EPs) have the unique challenge of providing appropriate analgesia and sedation at all hours of the day to all types of patients in all circumstances. Unfortunately, many feel uncomfortable with this task, and many patients suffer needlessly from oligoanalgesia.<sup>23 Lewis L., Lasater L.C., Brooks C.B. Are emergency physicians too stingy with analgesics? South Med J 1994 ;  87 : 7-9

Cliquez ici pour aller à la section Références, 50 Wilson J.E., Pendelton J.M. Oligoanalgesia in the emergency department Am J Emerg Med 1989 ;  7 : 620  [cross-ref]

Cliquez ici pour aller à la section Références</sup> Even when patients require orthopedic consultation, awaiting such service in pain is not acceptable.

Although all of the agents and methods discussed in this article may not be available in all EDs, the principles are the same for all agents and techniques. Lack of desired medications can be the result of lack of well-established protocols or simply a lack of appreciation for the types of care required by patients in the emergency setting. Ideally, guidelines for administering systemic analgesia and sedation should be developed in a multidisciplinary fashion involving emergency physicians, anesthesiologists, pediatricians, surgeons, and nurses, with special attention paid to the needs of the patient in the ED. All health care personnel have a vested interest and duty to alleviate pain and anxiety.